Study Finds Nursing Home Quality Measures Needed

New research examining the relationship between nursing home quality measures has reported alarming statistics on hospitalization rates of Medicare patients in nursing homes, averaging 25% and reaching as high as 38% in some facilities. Conducted by the Department of Health and Human Services Office of Inspector General (OIG), the study is concluded with a request that the Centers for Medicare & Medicaid Services (CMS) make the appropriate changes to implement quality measures.

Harms attributed to the frequent hospitalization of nursing home residents are many. In particular, research shows that the chances that elderly patients will have negative and harmful experiences during a facility transfer are high. Further, facility transfers and hospitalizations of Medicare beneficiaries is extremely expensive, and the annual budget for these services exceeds $14 billion nationally.

Research was conducted using information from a government billing and administrative database that stores all information about Medicare patients who transferred from a nursing home residence to inpatient hospital treatment in 2011.

According to the study, the national hospitalization rate for nursing home residents on Medicare was an average of 25%. Some areas of the country had significantly higher hospitalization rates, such as Louisiana, which reached 38%. While the hospitalization rate of for-profit facilities was slightly above the national average, the hospitalization rate of government and not-for-profit nursing homes were below the national average.

So what’s the difference between not-for-profit and private nursing homes that leads to the discordance in hospitalization rates? The answer: Researchers won’t know until nursing home quality measures are implemented across the board.

Government-operated assisted living facilities are required to use a Five-Star Rating System to keep track of nursing home quality measures and hospitalization rates. Reports from these nursing home quality measures reveal several correlations that may contribute to increased hospitalization rates. For example, the OIG found an especially remarkable relationship suggesting a relationship between high hospitalization rates and low staffing rates in the nursing homes.

The report concludes that establishing a system of nursing home quality measures will help identify preventable environmental conditions that may lead to hospitalization and reduce the associated costs. As is explained in the report, “Adding a measure of hospitalization rates to the existing QMs not only would enable nursing homes and the public to compare these rates across nursing homes, but also would provide greater incentive for nursing homes to reduce avoidable hospitalizations.” Such measures include the percentage of patients who received particular vaccines, had diagnosed cases of pressure ulcers, self-report moderate to severe pain, receive antipsychotic medications, and so on.

The CMS fully supports these conclusions and strongly recommends that nursing home quality measures be developed and implemented in order to learn more about hospitalization rates, particularly in those instances with hospitalization rates that are higher than the national average. The CMS intends to develop plans for a unified nursing home quality measure and submit it to the National Quality Forum as soon as the end of 2013.

As founder and CEO of General Medicine PC, the nation’s premier post-hospitalist care company,Tom Prose leads an exceptional team of internal medicine, geriatrics and healthcare administration specialists.